Should "Blood Doping" and Erythropoietin (EPO) Use Be Accepted in Sports?

Norman Fost, MD, MPH, Professor and Director of the Medical Ethics Program at the University of Wisconsin, stated the following in a July 2004 commentary piece published by Virtual Mentor titled "Performance-Enhancing Drugs in Sports":

"Enhancing human bodily function is, of course, common in health care on the planet Earth. Pediatricians enhance the immune system of children by administering vaccines. Innumerable researchers, with public funds, try to extend the normal life span. And of course, coaches, trainers, and physicians work feverishly to enhance athletic performance in hundreds of ways, often with assists from unnatural machines, diets, supplements, and drugs.

It is now standard practice...for long-distance runners and bicyclists to raise their hemoglobin concentration to unnatural levels to enhance performance. There is no moral outrage about this if it is done by simply working at a high altitude for a few months before the competition, or sleeping in a low-oxygen tent. But if an athlete autotransfuses his own natural blood before an event, or uses the approved version of erythropoetin, he is accused of 'blood doping' and may be banned for life.

If enhancement is the moral linchpin of this policy, we should be equally critical of all athletes who seek to enhance their performance, whatever the method...The quest for enhancement - to improve on normal bodily function - is
inherent in sports and in health care. If the moral crusade against [blood doping] is to be based on rational argument, rather than hysteria, a
better case needs to be made."

Bennett Foddy, DPhil, Harold T. Shapiro Postdoctoral Fellowship in Bioethics at the Center for Human Values at Princeton University, and Julian Savulescu, PhD, Professor and Uehiro Chair in Practical Ethics at the University of Oxford, in their June 2007 Principle of Health Care Ethics article "Ethics of Performance Enhancement in Sport: Drugs and Gene Doping," wrote:

"Playing sport at an elite level is not suicide, but neither is steroid use. To be sure, elite athletes are healthier on average than any morbidly obese person. But elite athletes in some sports can expect to have a serious medical problem every year or two.

This is not true of EPO, taken at a reasonable dosage. Even at very high dosages, and even if we take into account the poorly - substantiated rumours of EPO - related deaths, EPO does not present any risks that cannot be found from just over-training or especially from hypoxic training. If you have a low haematocrit for genetic or dietary reasons, EPO could actually improve your health."

Bode Miller, professional alpine skier and five-time Olympic medalist, in an Oct. 16, 2005 Times Online article titled "War On Drugs Must Continue," was quoted as having said the following:

"I'm surprised [EPO is] illegal, because in our sport, it would be pretty minimal health risks, and it would actually make it safer for the athletes, because you'd have less chance of making a mistake at the bottom and killing yourself."

The American College of Sports Medicine (ACSM), considered the world's largest sports medicine and exercise science organization, issued the following information in an Oct. 1996 position paper titled "The Use of Blood Doping as an Ergogenic Aid":

"It is the position of the American College of Sports Medicine that any blood doping procedure used in an attempt to improve athletic performance is unethical, unfair, and exposes the athlete to unwarranted and potentially serious health risks...

All blood doping procedures have attendant medical risks that can be serious and reduce athletic performance. These known risks are amplified by improper medical controls, as well as the interaction between dehydration with exercise and environmental stress. Finally, the medical risks associated with blood doping have been estimated from carefully controlled research studies and medically unsupervised use of blood doping will increase these risks."

Mario Cazzola, MD, Editor-in-Chief of Haematologica, wrote the following information in a June 2000 article titled "A Global Strategy For Prevention and Detection of Blood Doping With Erythropoietin and Related Drugs" published by his journal:

"As physicians, one of our major duties is to prevent diseases, and we have sworn this with the Hippocratic Oath. Since blood doping exposes athletes to several medical risks, we must be against blood doping, and more generally against any form of doping. Blood doping is not an abstract, intellectual challenge on how to circumvent sports regulations licitly, but a betrayal of the Hippocratic Oath for the physicians who are involved in it. Sport is intended to improve people's health, doping worsens it."

Geoffrey Wheatcroft, a British journalist and writer, wrote the following in a May 28, 2006 article titled "Illegal Drug Use Makes Cycling a Blood Sport," published by the Independent News and Media Corporation at Independent.ie:

"An argument has been made that athletes should be able to take anything
they like. But apart from the fact that doping is cheating, it is very
dangerous. Steroids have several unpleasant side effects - Bonds's
former girlfriend says that he had acne on his back and was often
impotent - but EPO is much worse. It increases energy by thickening the
blood, but this makes it harder to circulate. That's why we knew all
too well when it arrived on the sporting scene. Between 1987 and 1992,
seven young Swedish orienteering athletes and 20 Belgian and Dutch
cyclists died mysteriously from nocturnal heart attacks."

Jay P. Granat, PhD, Psychotherapist and Founder of StayInTheZone.com, stated the following in his Sep. 27, 2005 Stay in The Zone blog entry titled "Sports Psychology: How to Stop Blood Doping in Sports":

"Where the dangers of blood doping are concerned, I pointed out the following points:

1. Research on doping indicates that it can harm the immune system,cause infections, serious clots and death.

2. I have had several patients who were involved with doping and steroids and they present like addicts. They believe they can not perform or cope without using these substances. We don't need more addicts in sports or in society at large.

3. We have enough instances of cheating in sports, in politics and in business. We don't need another way for people to bend or break the rules.

4. The beauty of sport is you have athletes working hard and competing against one another. The winner in these contests should be the athlete with the most skill and with the best performance - not the athlete with the most devious pharmacist or transfusionist."